What is a Weight Inclusive Approach (June 2021)

It seems that every day a new client, or a current client, shares with me that they are interested in “losing weight.” I let them know that I don’t provide diets, but that I can help them develop a healthier, more positive relationship with food and their body. There’s usually a pause, then they ask me, “What does that mean?” I explain that I help clients understand the behaviors they engage in and what purpose they serve, and how to incorporate behaviors that can support them in feeling better in their body. Together, we explore the purpose that their destructive behaviors served while beginning to focus on behaviors that can improve their emotional and physical well-being—for example, their feelings and their blood work. The emphasis on “weight loss” is removed, because weight is not a behavior.

In a journal article titled “The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss,” psychologist Tracy Tylka and colleagues explain the reason that a “weight-inclusive” approach is more effective than a “weight-normative” approach. A weight-normative approach focuses on weight and weight loss as the main focus of health, whereas a weight-inclusive approach looks at health and well-being in multi-faceted way, including physical, behavioral and psychological perspectives. A weight-normative approach is strongly tied to diet culture and can lead people down the path of weight cycling, which research shows can do more harm than good. When clinicians have not addressed their own concerns around bodies and food, this can contribute to appearance- or weight-based bias, which can have a negative effect on client care.

As I discuss in my book, weight bias in the medical community is common and is not well understood.  When we are open to learning and fully understanding the principles of Health at Every Size (HAES), we begin to recognize that bodies come in all different shapes and sizes and we can’t look at a body and determine if it is “healthy” or “unhealthy” based on what we see. A weight-inclusive, HAES-informed approach allows clinicians to be able to listen to the lived experience of the client and encourage families to not judge foods as “good” or “bad,” have more meals together as a family and create boundaries that end conversations around bodies, movement and food.

When we begin to understand that respectful care is necessary for all bodies, including understanding the reasons someone may not be interested in engaging in any form of movement, this knowledge can help us in our approach. Perhaps our client is movement-averse because they were made fun of in P.E. class, were never fast or coordinated when playing on the playground, or became self-conscious because of unkind comments about their body. Whatever the reason, it is the responsibility of a client’s clinicians and loved ones to hear them out, listen without judgment, and strive to do better in supporting them, so the client is open to engaging in intuitive movement—in other words, movement that is fun and pleasurable to their body.

I hope this brief overview will encourage you to read more about body acceptance and HAES, as well as address any biases or lack of knowledge you have about the weight-inclusive approach.

References:

• Tylka TL, Annunziato DB, Burgard D, et al. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. Journal of Obesity, 2014;2014:983495. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132299/pdf/JOBE2014-983495.pdf
• Bacon L. Health at Every Size: The Surprising Truth about Your Weight. Dallas TX: Benbella Books, 2008.
• Bacon L, Aphramor L. Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight. Dallas TX: Benbella Books, 2014.
• Goldberg R. The Eating Disorder Trap: A Guide for Clinicians and Loved Ones. Alpharetta, GA: Booklogix, 2020.
• Puhl R, Latner JD, King KM, Luedicke J. Weight Bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes. International Journal of Eating Disorders. 2014;47(1): 65-75. https://pubmed.ncbi.nlm.nih.gov/24038385/